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Research report
Baseline and longitudinal change in blood pressure and mortality in a Chinese cohort
  1. Jian-Bing Wang1,2,
  2. Qiu-Chi Huang1,
  3. Shu-Chang Hu1,
  4. Pei-Wen Zheng,
  5. Peng Shen3,
  6. Die Li1,
  7. Huai-Chu Lu3,
  8. Xiang Gao4,
  9. Hong-Bo Lin3,
  10. Kun Chen1,2
  1. 1Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang University, Hangzhou, China
  2. 2Research Center for Air Pollution and Health, Zhejiang University, Hangzhou, China
  3. 3Department of Chronic Disease and Health Promotion, Yinzhou District Center for Disease Control and Prevention, Ningbo, China
  4. 4Department of Nutritional Sciences, The Pennsylvania State University, Philadelphia, Pennsylvania, USA
  1. Correspondence to Professor Kun Chen, Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang University, Hangzhou 310058, China; ck{at}zju.edu.cn

Abstract

Background A J-curve association has been demonstrated for blood pressure (BP) and all-cause mortality, but data on longitudinal change of BP and mortality in Chinese population are limited.

Methods We performed a retrospective cohort study to examine the association between BP (at baseline and longitudinal change) and risk of mortality in Yinzhou District, Ningbo, China, based on the Yinzhou Health Information System. At baseline, a total of 181 352 subjects aged over 18 years with at least one BP examination record were recruited through the Yinzhou Health Information System. The final analysis was restricted to 168 061 participants after exclusion of outliers of BP.

Results A U-shaped association was observed for BP at baseline and risk of total and cardiovascular mortality. When compared with normotensive participants, patients with hypotension (HRs=1.51, 95% CI 1.21 to 1.88) and stage 3 hypertension (1.28, 95% CI 1.09 to 1.50) had an increased risk of all-cause mortality. Relative to stable BP of normotension, having a rise in BP from normotension to hypertension or from prehypertension to hypertension both conferred an increased risk of total and cardiovascular mortality (total: 1.39 (95% 1.10 to 1.75) and 1.40 (95% 1.15 to 1.69); cardiovascular: 2.22 (95% CI 1.35 to 3.65) and 1.89 (95% CI 1.20 to 2.96), respectively).

Conclusions Our findings emphasise that hypotension and stage 3 hypertension were associated with an increased risk of all-cause mortality. Longitudinal change from normotensive or prehypertensive levels to 140/90 mm Hg or higher could increase the risk of total and cardiovascular mortality.

  • cardiovascular disease
  • cohort studies
  • blood pressure
  • stroke

https://doi.org/10.1136/jech-2018-211050

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    Footnotes

    • J-BW and Q-CH contributed equally.

    • Contributors J-BW and KC had all access to the data in the study and took responsibility for the integrity of the data. J-BW, XG, H-BL and KC contributed to the concept and design. Q-CH, S-CH, P-WZ, PS, DL and H-CL obtained the database. J-BW and Q-CH analysed the data and wrote the first draft. All authors have reviewed and approved the final draft.

    • Funding This work was supported by Research Center for Air Pollution and Health, Zhejiang University (519600-I21502).

    • Disclaimer The sponsors had no role in the design and conduct of the study; in the collection, management, analysis and interpretation of the data; or in the preparation, review or approval of the manuscript.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval Institute Review Board of the Research Center for Air Pollution and Health of Zhejiang University.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data available.

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